SR-1

FORM FOR APPLICATION_ FOR LEAVE S.R.-1

 (See Supplementary Rule 216)

Note: Items 1 to 11 must be filled in by all applicants whether gazette or non-gazette

1. Name of the applicant

2. Leave rules applicable

3. Post held

4. Department, Office and Section

5. Pay

6. House rent allowance, conveyance

allowance or other compensatory

allowances drawn in the present post.

7. Nature and period of leave applied for

and date from which required

8. Sunday and holidays, if any proposed

to be prefixed/suffixed to leave.

9. Ground on which leave is applied for

10. Date of return from last leave and the

nature and period of that leave

11. I proposed / do not proposed to avail myself of leave travel concession in the

block years ………………….. during the ensuing leave.

12. (a) I undertake to refund the difference between the leave salary drawn during

leave on average pay/commuted leave and that admissible leave on half average

pay half leave, which would not have been admissible had the provision to

F.R.81(b)(II) Rule II(c) (III) of the revised Leave Rules, 1933 not been applied in

the event of my retirement from service at end or during the currency of the leave.

12. (b) I undertake to refund leave salary drawn during leave not due which would not

Have been admissible had F.R.81 (c) Rule 11(d) of the Revised Leave Rule 1933

Not been applied, in the event of my voluntary retirement or resignation from

Service at any time I until earn half pay leave not less than the amount of leave not

due availed of by me.

Date ………………… Signature of applicant ……………………

13. Remarks and-or recommendation of the

Controlling  Officer.

Signature ……………………………….

Date …………………. Designation …………………………….

CERTIFICATE REGARDING ADMISSIBILTY OF LEAVE

(By Accountant General to the case of gazette Officers)

14. Certified that ………………………………………………….. [Nature of leave]

for ………................ from [period] ………….…………… to ……………………

is admissible under rule ……………………… of the …………………... Rules.

Signature ……………………………….

Date …………………. Designation …………………………….

______________________________________________________________________________

I the applicant is drawing any compensatory allowance the sanctioning authority

should state whether on the expiry of leave he is likely to return the same post or

to another post carrying a similar allowance.